Documents Incorporated By Reference - Adopt-a-Highway
TITLE 21. PUBLIC WORKSDIVISION 2. DEPARTMENT OF TRANSPORTATIONChapter 23. Adopt-A-Highway ProgramDOCUMENTS INCORPORATED BY REFERENCEForms:1. MTCE-018 Adopt-A-Highway Program Application(Rev 07/09)2. TR-0103Adopt-A-Highway Permit Application(Rev 09/09)3. TR-0121Encroachment Permit (Adopt-A-Highway)(Rev. 02/08)4. MTCE-09 Attachment A (Adopt-A-Highway Special Provisions)(Rev. 07/09)5. TR-0156(Rev. 09/09)Adopt-A-Highway Permit Special Provisions6. MTCE-10 Safety Orientation Checklist for Adopt-A-Highway Contractors(Rev. 06/09)7. MTCE-02 Adopt-A-Highway Safety Orientation Checklist for Volunteers(Rev. 07/09)Handouts:8. Adopt-A-Highway Recognition Panel Design Guidelines(Rev. 10/09)9. Working With Contractors(Rev. 12/08)10. Recognition Panel Installation by Adopt-A-Highway Service Contractors(Rev. 10/09)11. Preparing a Vegetation Control Site Plan and Work Schedule(Rev. 07/09)12. Preparing Tree and Shrub Planting Plans and Work Schedule(Rev. 07/09)13. Preparing Wildflower Planting Plans and Work Schedule(Rev. 07/09)14. Instructions for Using Mulch(Rev. 09/09)15. Caltrans Licensing Requirements for Adopt-A-Highway VolunteersUsing Herbicides(Rev. 02/06)Director’s Policy:16. California Department of Transportation, DP-01-R6, Director’sPolicy on Equal Employment Opportunity(Rev. 07/06)
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONADOPT-A-HIGHWAY PROGRAM APPLICATIONFOR CALTRANS’ USE:DATE RECEIVED - INITIALSDATE COMPLETEDMTCE 018 (REV 7/2009)The Adopt-A-Highway Program and it's courtesy signs are not a forum for advertisement or public discourse. Adopters arenot guaranteed a sign. Signs will display the name of the individual, organization, agency, or business providing the adoptionservice. Subject to approval, organizations and businesses may display their logo along with their name, or, they may displaytheir logo by itself.Program applications are subject to review and approval. If a requested location is already adopted, your group will be placedon a waiting list. If a requested location is available for adoption, you will be sent an Adopt-A-Highway Encroachment PermitApplication to sign and return.ADOPTION TYPE(S)1LR: Litter RemovalVC: Vegetation Control1WF: Wildflower Planting1GR: Graffiti RemovalTP: Tree and Shrub Planting1SWP: "Spot" Wildflower Planting1,2Once a requested location becomes available, you will be required to submit work plans and a work schedule for review and approval.2OtherSpot wildflower planting adopters do not receive a sign.ADOPTION SITE(S) REQUESTED: If you do not know a site’s post mile range, please call 1-866-236-7824 for assistanceor leave the field empty and your District Adopt-A-Highway Coordinator will call you.TYPECOUNTYROUTEPOST MILE RANGE - LOCATION TYPEDIRECTION(S)TYPECOUNTYROUTEPOST MILE RANGE - LOCATION TYPEDIRECTION(S)TYPECOUNTYROUTEPOST MILE RANGE - LOCATION TYPEDIRECTION(S)TYPECOUNTYROUTEPOST MILE RANGE - LOCATION TYPEDIRECTION(S)TYPECOUNTYROUTEPOST MILE RANGE - LOCATION TYPEDIRECTION(S)North or East BoundSouth or West BoundNorth or East BoundSouth or West BoundNorth or East BoundSouth or West BoundNorth or East BoundSouth or West BoundNorth or East BoundSouth or West BoundAPPLICANT INFORMATION: Businesses must submit a copy of their business license or other proof of business name.WORK WILL BE PERFORMED BY (Minimum age for participants is 16 years)INDIVIDUAL, ORGANIZATION, AGENCY, OR BUSINESS NAMEVolunteers: AgedADDRESS16 CITYNAME OF PRIMARY CONTACT (Must be at least 21 years old)TITLEPHONE NO.FAXALT. PHONE NO.18 STATEHired ContractorZIP CODEE-MAILALTERNATE CONTACT (Required, must be at least 21 years old)SIGNATURE OF APPLICANT’S PRIMARY CONTACTALT. CONTACT'S PHONE NO.DATECONTRACTOR INFORMATION: Complete only if application is submitted by contractor on behalf of a sponsor group.CONTRACTOR’S BUSINESS NAMECONTRACTOR REPRESENTATIVESIGNATURE OF CONTRACTOR’S REPRESENTATIVERecognition Panel Installation and Removal RequestedDATEAPPLICANT ELIGIBILITY APPROVAL - FOR CALTRANS’ USE:SIGNATURE OF DISTRICT DEPUTY DIRECTOR OF MAINTENANCEApprovedDATEDeniedPERSONAL INFORMATION NOTICE: Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices Act of 1977 (Civil Code Sections 1798, et seq.), noticeis hereby given for the request of personal information by this form. The requested personal information is voluntary. The principal purpose of the voluntary information is tofacilitate the processing of this form. The failure to provide all or any part of the requested information may delay processing of this form. No disclosure of personal informationwill be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977. Each individual has the right upon request and proper identification to inspect allpersonal information in any record maintained on the individual by an identifying particular.ADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write toRecords and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONPERMIT NO.ADOPT-A-HIGHWAY PERMIT APPLICATIONTR-0103 (REV. 09/2009)DIST/CO/RTE/PMPERSONAL INFORMATION NOTICE: Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information PracticesAct of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal information bythis form. The requested personal information is voluntary. The principal purpose of the voluntary information is tofacilitate the processing of this form. The failure to provide all or any part of the requested information may delayprocessing of this form. No disclosure of personal information will be made unless permissible under Article 6, Section1798.24 of the IPA of 1977. Each individual has the right upon request and proper identification to inspect all personalinformation in any record maintained on the individual by an identifying particular.FOR CALTRANS USE (Date Received)ADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats. For informationcall (916) 653-3657 or TDD (916) 654-3880 or write to Records and Forms Management, 1120 N Street, MS-89,Sacramento, CA 95814.PERMISSION IS REQUESTED TO ENCROACH ON THE STATE HIGHWAY RIGHT OF WAY AS FOLLOWS:Please call 1-866-ADOPTAHWY for assistance in completing this form.APPLICATION TYPE (Check One)Adoption RenewalNew AdoptionWaiting List PlacementADOPTION TYPELitter RemovalSeedling Tree and Shrub PlantingGraffiti RemovalWildflower Planting and Vegetation ControlVegetation Control111"Spot" Wildflower Planting 1 ( "Spot" adoption participants receive no sign.)Recognition Panel Replacement. (Contractors only. Panels must be approved by the Department.)Other, describe:NOTE: Applications for new adoptions and adoption renewals will not be processed until required support documents have been received.1Plans and schedules are required. If herbicides will be used, a Pest Control Recommendation is required and the applicator must submit proof of appropriate licensingor certification by the Department of Pesticide Regulation.ADOPTION SITE LOCATIONCOUNTYROUTEPOST MILE RANGEDIRECTION(S)North BoundBEGINNING POST MILE DESCRIPTION (Landmark, cross street, etc.)South BoundEast BoundWest BoundEND POSTMILE DESCRIPTION (Landmark, cross street, etc.)APPLICANT INFORMATIONDOUBLE PERMITORGANIZATION/BUSINESS NAMECheck if applicant is a contractor.PRIMARY CONTACT (Unless otherwise notified, Caltrans assumes that the primary contact is the group's safety leader)TITLEADDRESSCITYSTATEPHONE NUMBERALTERNATE PHONE NUMBERFAXALTERNATE CONTACT (Required)ZIP CODEE-MAILCheck if alternate contactis the group's safety leader.ALTERNATE CONTACT'S PHONE NUMBERWORK WILL BE PERFORMED BYVolunteers over the age of 18Volunteers over the age of 16Hired Contractor (name)AUTHORIZED SIGNATURE The undersigned agrees that work will be done in accordance with Caltrans rules and regulations and subject to inspection and approval.The Adopt-A-Highway Program and it's courtesy signs are not a forum for advertisement or public discourse.SIGNATURE OF PRIMARY CONTACTFM 90 1180 MDATE
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONENCROACHMENT PERMIT (ADOPT-A-HIGHWAY)Permit No.TR-0121 (REV. 02/2008)Dist/Co/Rte/PMIn compliance with (Check one):XDateYour application ofUtility Notice No.ofAgreement No.Fee PaidDeposit N/A N/APerformance Bond Amount (1)Payment Bond Amount (2) N/A N/AofBond CompanyofBond Number (1)N/AR/W Contract No.N/ABond Number (2)N/ATO:, PERMITTEEand subject to the following, PERMISSION IS HEREBY GRANTED to:Perform the following activities onDISTRICT / COUNTY / ROUTE / POSTMILE RANGE / DIRECTION(S)Litter Removal.Seedling Tree and Shrub Planting.Graffiti Removal.Wildflower Planting and Vegetation Control.Vegetation Control."Spot" Wildflower Planting.Recognition Panel Replacement. (By contractors only. Panels must be approved by the Department.)Other, describe:NO ONE UNDER 16 YEARS OF AGE IS ALLOWED TO PARTICIPATE ON STATE RIGHT-OF-WAY.THIS PERMIT IS NOT A PROPERTY RIGHT AND DOES NOT TRANSFER WITH THE PROPERTY TO A NEW OWNER.The following attachments are also included as part of this permit (Check applicable):XXPlanting Plan, Work Plan, and Work Schedule.Adopt-A-Highway Permit Special Provisions.Attachment A (Adopt-A-Highway Special Provisions).Vegetation Control Plan, Work Plan, and Work Schedule.ADVANCE NOTIFICATION OF WORK: Before each work occasion, the Permittee shall notify the Department's Maintenance FieldRepresentative at least five working days, but no more than one month, prior to start of any work to ensure coordination with other activities.DEPARTMENT'S MAINTENANCE FIELD REPRESENTATIVEPHONE NUMBERPermittee's work shall be subordinated to State operations and shall not interfere with State forces or State's contractors.YesThe information in the environmental documentation has been reviewed and considered prior toX Noapproval of this permit.This permit expires on, 20This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized.No project work shall be commenced until all other necessary permits and environmental clearances have been obtained.APPROVED:, District DirectorBY:, District Permit EngineerADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 653-3657 or TDD (916) 654-3880 or write to Recordsand Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONATTACHMENT A (ADOPT-A-HIGHWAY SPECIAL PROVISIONS)MTCE-09 (REV 7/2009)1. DEPARTMENTAL CONTACTS:District Adopt-A-Highway Coordinator (Processes applications, answers questions regarding program policy, maintains programdata, receives contact information changes.)Name:Phone:Address:Maintenance Supervisor or Designee (Receives five-day advance notice of work, provides additional supplies and equipmentthroughout the permit period, arranges for collection of filled litter bags, hazardous materials, and large items.)Name:Phone:Address:Representative Providing Safety Orientation (Answers safety-related questions, provides initial supply of safety equipment.)Name:Phone:Address:2. WORK FREQUENCY: (Check all that apply)Litter shall be removed a minimum of times per year.Graffiti shall be removed within calendar days of notification.Vegetation shall be controlled a minimum of times per year.Planting, vegetation control, and other activities shall be performed per permittee's attached plans and schedules.3. WORK DAYS AND HOURSWork shall not be scheduled by any permittee during the holiday periods listed in Special Provisions 10. In addition, work shallnot be scheduled:Volunteer litter removal groups shall schedule work during the national cleanup events listed in Special Provisions 11 (weatherpermitting). In addition, volunteer litter removal groups shall schedule work:Site Access – Direction 2:4. SITE ACCESS – Direction 1:Walk-on entry and exit points?YesNoWalk-on entry and exit points?YesNoShoulders for drop-off and pick-up?YesNoShoulders for drop-off and pick-up?YesNoSpace to park off of shoulders?YesNoSpace to park off of shoulders?YesNoComments/Recommendations:5. WORK AREA DESCRIPTION – Direction 1:Comments/Recommendations:WORK AREA DESCRIPTION – Direction 2:Begin:Begin:End:End:6. WORK PROCEDURES In addition to the restrictions listed in item 15 of the Special Provisions, work may not be performed in thefollowing portions.Direction 1:Direction 2:GROUP NAME/CONTRACTOR NAMEADOPTION TYPE AND LOCATIONADOPT-A-HIGHWAY COORDINATOR SIGNATUREDATE PREPAREDADA NOTICE: For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write to Records and FormsManagement, 1120 N Street, MS-89, Sacramento, CA 9581 4.
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONPage 1 of 3ADOPT-A-HIGHWAY PERMIT SPECIAL PROVISIONSTR-0156 (Rev. 09/2009)1.AUTHORITY: The Department’s authority to issue encroachmentpermits is provided under Division 1, Chapter 3, Articles 1 - 3,Section 660 to 734 of the Streets and Highways Code.2.REVOCATION/CANCELLATION: This permit may be revokedby the Department for noncompliance with permit provisions orfor failure of the permittee, or their representative to adhere todirection given by a Departmental representative. These provisions are subject to modification or abrogation at any time. Thispermit may be temporarily suspended due to construction orother State operations at, or within, the vicinity of the site.Permittee may cancel their permit at any time without consequencefrom the Department. Permittees using contractors are responsiblefor terminating those arrangements.3.ASSIGNMENT: No parties other than the permittee, or permittee’sauthorized representative, are allowed to work under this permit.4.ACCEPTANCE OF PROVISIONS: Permittee understands andagrees to accept these Adopt-A-Highway Permit Special Provisionsand all attachments to this permit, for any work to be performedunder this permit. It is understood and agreed by the permittee thatperforming work under this permit shall constitute acceptance.5.PERMITTEE RESPONSIBILITY: No person shall enter the State’sright of way to perform work until the Department’s MaintenanceSupervisor has given the permittee’s group/crew leader a safety orientation, and, all participants have received safety training from thepermittee’s group/crew leader as described in items 20 and 24.It is the responsibility of the permittee to notify the District AdoptA-Highway Coordinator of any change of permittee's address, phonenumber, or contact person.6.PLAN CHANGES: Changes to plans, specifications, and permitprovisions are not allowed without prior approval from the Department.7.AGE OF PARTICIPANTS: No minors under the age of 16 are permitted to participate in the program. Minors, 16 and 17 years of age,may participate; however, there must be one adult supervisor forevery five minors present at the work site. The adult supervisormust be at least 21 years old and must walk along with the group.Volunteer group leaders must be adults who are at least 21 years old.8.BEGINNING OF WORK: Work authorized by this permit shallbegin after a safety orientation has been completed and within30 calendar days from the date of issuance, regardless of whetheror not the permittee's Adopt-A-Highway courtesy sign(s) and/orrecognition panel(s) have been installed. Work shall not be discontinued if the permittee's courtesy sign is damaged or stolen.9.ADVANCE NOTICE OF WORK: Permittee must notify theDepartment’s Maintenance Supervisor listed on Attachment A(Adopt-A-Highway Special Provisions) of their plans to work atleast five days, but no more than one month, before the event.10. WORK DAYS AND HOURS: Work must be performed duringdaylight hours. If weather (or other adverse circumstance) causesdecreased visibility or a public hazard, work shall immediately bediscontinued. Work shall not be conducted on, or within twenty-fourhours preceding, the following holidays or holiday weekends: NewYear's Day, Martin Luther King, Jr.'s Birthday, Washington's Birthday, Cesar Chavez's Birthday, Easter, Memorial Day, IndependenceDay (July 4th), Labor Day, Veteran's Day, Thanksgiving and the dayafter, and Christmas. Unless specified, work is permitted the dayfollowing a legal holiday or holiday weekend.11. PARTICIPATION IN STATEWIDE EVENTS: Weather permitting, volunteer litter removal groups shall schedule work during the"Great American Cleanup-California" (March-May) and "CaliforniaCleanup Day" (September) events in order to support Adopt-AHighway's participation in national and international cleanup events.12. CONFLICTING ENCROACHMENTS: Permittee shall yield startof work to ongoing, prior authorized, work adjacent to or within thelimits of the project site.13. PERMIT AT WORK SITE: Permittee shall keep the complete permit package (Adopt-A-Highway Encroachment Permit, Adopt-AHighway Permit Special Provisions, and if applicable, plans andwork schedule) or a copy thereof, at the work site and show it uponrequest to any Department representative or law enforcement officer. If the permit package is not kept and made available at the worksite, the work shall be suspended. In addition, a copy of the encroachment permit must be displayed in the windshield of each vehicle parked on the right of way. Vehicles without permits mayreceive traffic citations.14. PARKING AT THE WORK SITE: Participant’s personal vehiclesshall not interfere with the free flow of traffic or pedestrians. Vehiclesused to transport participants or materials may legally park on theright of way provided that they are located completely off of thepavement and a minimum of six feet from any traffic lane. If this is notpossible, participants must walk to and from the site or, if the sitehas a shoulder, participants can use a drop-off and pick-up arrangement.15. WORK PROCEDURES: Work shall proceed in the direction facingtraffic. A posted safety lookout shall be used when fellow participants are unable to watch oncoming traffic.Work shall not be performed on or within six feet from any trafficlane or on median strips. Participants shall not walk or run acrossaccess-controlled highways (freeways), including on-ramps and offramps unless there are crossalks. Participants shall not work onunstable or slippery ground, on slopes greater than approximately40º, on bridges, in tunnels, or inside culverts. Unless excluded by theaforementioned conditions, or entered on Attachment A, Work Procedures, litter removal and vegetation control shall be performedbehind soundwalls.16. PUBLIC TRAFFIC CONTROL: All forms of traffic control, including shoulder, lane, and ramp closures, signs, cones, vehicles, orany other traffic control device are prohibited under this permit.17. SAFETY EQUIPMENT: It is required that all participants wearhard hats, safety vests, gloves, and protective eye wear while on theState's right of way. The Department will provide these and, if needed,litter pickers to volunteers free of charge. In addition, participantsare required to wear long pants and substantial leather shoes or bootswith ankle support. Any State-furnished, personal protective equipment, unused materials, and tools shall be returned upon terminationof the permit.18. LITTER BAGS: Participants shall use white, Adopt-A-Highwaybags provided by the Department. Securely tied, filled bags must beplaced at least six feet from the edge of traffic lanes and off of pavedshoulders. Bags must be placed in locations where they are not obstructing drainage and where Departmental maintenance forces caneasily see them and safely retrieve them. Whenever possible, bags
STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATIONPage 2 of 3ADOPT-A-HIGHWAY PERMIT SPECIAL P
MTCE-02 Adopt-A-Highway Safety Orientation Checklist for Volunteers (Rev. 07/09) Handouts: 8. Adopt-A-Highway Recognition Panel Design Guidelines (Rev. 10/09) . The Adopt-A-Highway Program and it's courtesy signs are not a forum for advertisement or public discourse. Adopters are not
Adopt-A-Highway Program Guidelines and Coordinators Handbook Adopt-A-Highway Signs March 2008 2-3 PURPOSE OF SIGNS Caltrans recognizes donations made through the Adopt-A-Highway Program with Adopt-A-Highway courtesy signs. Courtesy signs also alert motorists and the California Highway Patrol that workers may be present on the roadside.File Size: 964KB
institution incorporated in Hong Kong by or under the Companies Ordinance (Cap. 32) or any other Ordinance and any reference to a bank incorporated in Hong Kong, a deposit-taking company incorporated in Hong Kong or a restricted licence bank incorporated in Hong Kong shall be construed accordingly; “authorized institution incorporated outside .
Jul 01, 2014 · D1.10 Adopt-A-Highway Program D1.10.1 Adopt-A-Highway Litter Procedures D1.10.2 Adopt-A-Highway Graffiti Operations D1.10.3 Adopt-A-Highway Program Roles and Responsibilities. D1.00 Introduction. D1.01 Policy. D1.02 Laws That Pertain to Litter, Debris, Disabled and Abandoned Vehicles. D1.03 Litter. D1.04 Debr
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Upload the e-Bid/ Quotation (bid) documents, technical documents, relevant documents & all the required documents as given below, which are available in the same folder named " Bidders Documents "System will prompt for digital signature certificate while uploading these documents. 4. Packet Bid System:
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TRONOX INCORPORATED MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL . Savannah site was transferred to an environmental response trust upon Tronox Incorporated’s emergence from bankruptcy on February 14, 2011. Tronox Incorporated has determined that the Savannah TiO . and tort liabilitie
Send comments (with copy to psa@ansi.org) to: Christina Earl, (315) 339-6937, cearl@esda.org TCIA (ASC A300) (Tree Care Industry Association) Revision BSR A300 (Part 3)-201x, Tree Care Operations - Tree, Shrub, and Other Woody Plant Management - Standard Practices (Supplemental Support Systems) (revision of ANSI A300 (Part 3)-2006)
